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Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care.

https://arctichealth.org/en/permalink/ahliterature298634
Source
BMC Fam Pract. 2018 01 09; 19(1):12
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-09-2018
Author
Elisabeth Björk Brämberg
Jarl Torgerson
Anna Norman Kjellström
Peder Welin
Marie Rusner
Author Affiliation
Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska institutet, 171 77, Stockholm, Sweden. Elisabeth.bjork.bramberg@ki.se.
Source
BMC Fam Pract. 2018 01 09; 19(1):12
Date
01-09-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Comorbidity
Delivery of Health Care - organization & administration - standards
Female
General Practice - methods - organization & administration
Health Services Accessibility - standards
Health Status Disparities
Humans
Male
Mental Disorders - epidemiology - physiopathology
Middle Aged
Needs Assessment
Qualitative Research
Quality Improvement
Sweden
Abstract
Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness.
Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated.
The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care).
Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.
PubMed ID
29316894 View in PubMed
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[A comparison of paying patients in private practice and in public dental service--found from the Harstad-study 1974]

https://arctichealth.org/en/permalink/ahliterature42567
Source
Nor Tannlaegeforen Tid. 1975 Sep;85(8):296-303
Publication Type
Article
Date
Sep-1975
Author
L A Heloe
B. Heloe
Source
Nor Tannlaegeforen Tid. 1975 Sep;85(8):296-303
Date
Sep-1975
Language
Norwegian
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Child
Child, Preschool
Comparative Study
English Abstract
Female
General Practice, Dental
Humans
Male
Middle Aged
Norway
Private Practice
Public Health Dentistry
Sex Factors
Social Class
Utilization Review
Abstract
Since 1950, the Public Dental Service (PDS) has gradually been developed in Norway. In addition to rendering free and systematic treatment to children aged 6--17 years, which has priority, the PDS also offers treatment to other categories of patients at fixed fees, generally lower than those in private practice. The purpose of the present study was to elucidate the impact made by PDS on the dental treatment pattern within one particular area (the district of Harstad with a population of approximately 29,000). Furthermore, the study included a description of the clientele in the PDS, excluding the "free clientele" aged 6--17, in relation to that treated in private practice. During a limited period in February--March 1974, all the 9 dentists in the PDS treating "paying clientele" and all the 9 private practitioners in the district, filled in a questionnaire by each patient visit (course of treatment) (Fig. 1). In addition to the information on social and demographic characteristics, data were also collected on dental treatment pattern, the treatment presently rendered, and the presence of teeth and possible dentures (Fig. 1). Four--fifths of the visits made by "paying clientele" were made in private practice, only one--fifth in the PDS. In private practice, rural people, women and people of young age were underrepresented. Children under 6 years of age comprised 3% of the clientele in private practice and 9% in the PDS. No significant difference was found between the two types of practice regarding the social class composition of the clientele. Dental status as measured by the occurrence of teeth and dentures was generally poorer among the PDS patients, seemingly due to the overweight of rural people and of those with an irregular or occasional treatment pattern. Totally 40% of all visits were made by regular treatment attenders. 20% of the services delivered were prophylaxes and/or periodontics, 56% were conservative and/or endodontic treatments. The introduction of the FDS in the district some 10--15 years ago has conceivably contributed to an overall increase in the demand for dental services, and to an improvement of denial treatment patterns. During this period, the number of public dentists has increased from 2--3 to a total of 12. Correspondingly, the number of private practitioners has increased from 5 to 9, of whom 2 work part time. The treatment attendance of some population subgroups is, however, still lagging behind: rural people, small children and persons over 50 years of age, and particularly people belonging to lower socio-economic brackets.
PubMed ID
1058460 View in PubMed
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Action research led to a feasible lifestyle intervention in general practice for people with prediabetes.

https://arctichealth.org/en/permalink/ahliterature258001
Source
Prim Care Diabetes. 2014 Apr;8(1):23-9
Publication Type
Article
Date
Apr-2014
Author
Helle Terkildsen Maindal
Ane Bonde
Jens Aagaard-Hansen
Author Affiliation
Section for Health Promotion and Health Services and Section of General Practice, Department of Public Health, Aarhus University, Denmark. Electronic address: htm@alm.au.dk.
Source
Prim Care Diabetes. 2014 Apr;8(1):23-9
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Body mass index
Clinical Competence
Denmark
Feasibility Studies
Female
General practice
Health Behavior
Health Knowledge, Attitudes, Practice
Health Services Research
Hemoglobin A, Glycosylated - metabolism
Humans
Life Style
Male
Middle Aged
Nursing Staff
Patient Education as Topic
Pilot Projects
Prediabetic State - blood - diagnosis - nursing - therapy
Referral and Consultation
Risk factors
Risk Reduction Behavior
Time Factors
Treatment Outcome
Abstract
To develop and pilot a feasible lifestyle intervention for people with prediabetes tailored for general practice. The study was designed to explore (i) what resources and competencies would be required and (ii) which intervention components should be included.
In the first of two action research cycles various interventions were explored in general practice. The second cycle tested the intervention described by the end of the first cycle. In total, 64 patients, 8 GPs and 10 nurses participated.
An intervention comprising six consultations to be delivered during the first year after identified prediabetes was found feasible by the general practice staff in terms of resources. Practice nurses possessed the adequate competences to undertake the core part of the intervention. The intervention comprised fixed elements according to structure, time consumption and educational principles, and flexible elements according to educational material and focus points for behaviour change. Clinical relevant reductions in patients' BMI and HbA1c were found.
A prediabetes lifestyle intervention for Danish general practice with potential for diabetes prevention was developed based on action research. The transferability of the developed intervention to other general practices depends on the GPs priorities, availability of practice nurses to deliver the core part, and the remuneration system for general practice. The long-term feasibility in larger patient populations is unknown.
PubMed ID
24361372 View in PubMed
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Acupuncture for infantile colic: a blinding-validated, randomized controlled multicentre trial in general practice.

https://arctichealth.org/en/permalink/ahliterature106166
Source
Scand J Prim Health Care. 2013 Dec;31(4):190-6
Publication Type
Article
Date
Dec-2013
Author
Holgeir Skjeie
Trygve Skonnord
Arne Fetveit
Mette Brekke
Author Affiliation
Department of General Practice, Institute of Health and Society , University of Oslo , Norway.
Source
Scand J Prim Health Care. 2013 Dec;31(4):190-6
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Acupuncture Therapy
Colic - therapy
Crying
Double-Blind Method
Female
General Practice - methods
Humans
Infant
Infant, Newborn
Male
Norway
Prospective Studies
Qualitative Research
Time Factors
Treatment Outcome
Abstract
Infantile colic is a painful condition in the first months of infancy. Acupuncture is used in Scandinavia as a treatment for infantile colic. A randomized controlled trial was carried out with the aim of testing the hypothesis that acupuncture treatment has a clinically relevant effect for this condition.
A prospective, blinding-validated, randomized controlled multicentre trial in general practice. Research assistants and parents were blinded.
13 GPs' offices in Southern Norway.
Three days of bilateral needling of the acupuncture point ST36, with no treatment as control.
113 patients were recruited; 23 patients were excluded, and 90 randomized; 79 diaries and 84 interviews were analysed.
Difference in changes in crying time during the trial period between the intervention and control group.
The blinding validation questions showed a random distribution with p = 0.41 and 0.60, indicating true blinding. We found no statistically significant difference in crying time reduction between acupuncture and control group at any of the measured intervals, nor in the main analysis of differences in changes over time (p = 0.26). There was a tendency in favour of the acupuncture group, with a non-significant total baseline-corrected mean of 13 minutes (95% CI -24 to + 51) difference in crying time between the groups. This was not considered clinically relevant, according to protocol.
This trial of acupuncture treatment for infantile colic showed no statistically significant or clinically relevant effect. With the current evidence, the authors suggest that acupuncture for infantile colic should be restricted to clinical trials.
Notes
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PubMed ID
24228748 View in PubMed
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[A current question: crammed registries and hollow physicians].

https://arctichealth.org/en/permalink/ahliterature134871
Source
Lakartidningen. 2011 Mar 23-29;108(12):649
Publication Type
Article
Author
Christer Petersson
Author Affiliation
FoU Kronoberg, Växjö. christer.petersson@Itkronoberg.se
Source
Lakartidningen. 2011 Mar 23-29;108(12):649
Language
Swedish
Publication Type
Article
Keywords
Checklist
General practice
Humans
Quality Assurance, Health Care
Registries
Sweden
PubMed ID
21534317 View in PubMed
Less detail

Acute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice.

https://arctichealth.org/en/permalink/ahliterature257384
Source
Dan Med J. 2014 Feb;61(2):B4801
Publication Type
Article
Date
Feb-2014
Author
Jens Georg Hansen
Author Affiliation
Rosenlunden 9, 9000 Aalborg, Denmark. jensgeorg@dadlnet.dk.
Source
Dan Med J. 2014 Feb;61(2):B4801
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Anti-Bacterial Agents - therapeutic use
Denmark
Double-Blind Method
Female
General Practice - methods - statistics & numerical data - trends
Health Care Surveys
Humans
Lung - physiopathology
Male
Maxillary Sinusitis - diagnosis - microbiology - physiopathology - therapy
Middle Aged
Penicillin V - therapeutic use
Physician's Practice Patterns - statistics & numerical data - trends
Prospective Studies
Questionnaires
Treatment Outcome
Young Adult
Abstract
The idea behind this thesis is to present how ARS and especially acute maxillary sinusitis in adults is diagnosed and treated in general practice. The study extends over many years, beginning with the first survey in 1991. Based on doctors' answers, we then investigated the diagnostic values ??of the symptoms, signs and examinations which the doctors reported using. All patients over 18 years suspected of acute maxillary sinusitis were included consecutively and only once and, after a clinical examination with the GP, they were offered the opportunity to enter into the prospective study referred to acute CT scan and by changes in the CT, immediately referred to sinus puncture. Both examinations were conducted at Aalborg Hospital. The disease was found most frequently in younger and 2/3 were women. The reason for this gender difference is unknown. We have assessed the diagnostic values of the symptoms, objective findings and investigations ??using 3 different reference standards: sinus puncture, microbiological diagnosis and CT scan described in three articles. In all examinations, it appeared that the usual signs and symptoms of acute maxillary sinusitis occur almost equally often and with a few exceptions in patients, with and without pus in the sinus cavities. Pain in the sinus cavities occurring in 95% of patients, and only elevated levels of CRP and ESR are significantly and independently associated with pus in the sinus cavities. This finding is surprising, because they are two nonspecific markers. CRP tested by near-patient testing has, within the investigations period, been introduced in general practice, and from 1999 the doctors also get reimbursed for performing the test. We have on this background originally defined a clinical criterion with pain over the sinuses accompanied by elevated values ??of CRP and/or ESR giving a sensitivity of 0.82, specificity 0.57, ppv 0.68 and npv 0.74. But looking at the ROC curve we suggest that a more clinical relevant diagnose will be based on use of CRP alone, as the test can be made easily and fast while the patient is in the clinic compared to the use of ESR. The disease is over-diagnosed in general practice. In only 53% of patients, who the GP suspected of having acute sinusitis, was there detected pus or mucopus at the sinus puncture, furthermore the patients' statements that they had had sinusitis was significantly negatively associated with current acute maxillary sinusitis. Almost all patients are prescribed topical treatment to the nose in the form of vasoconstrictor, and 50-70% also antibiotics. The most common bacteria that can be isolated are S. pneumoniae and H. influenzae. For many years the first drug of choice has been penicillin V, and treatment with penicillin V has followed Scandinavian recommendations. However, the resistance patterns in respect of H. influenzae have changed over the years and if the dominant flora is H. influenzae, then oral penicillin is not sufficient anymore, and should be replaced by amoxicillin with or without clavulanate. It is reported that the MIC of penicillin V is too high, such that oral dosage cannot provide sufficiently high concentrations. However, in daily clinical practice the doctor does not have the possibility to decide whether the infection is caused by either S. pneumoniae or H. influenzae, unless a sinus puncture is performed and it is not considered as a standard procedure. The recommended treatment is therefore starting with penicillin V, and at treatment failure switching to amoxicillin with or without clavulanate. It is well known that URTI's can exacerbate a chronic pulmonary disease - like asthma - in allergic patients, but this influence is also demonstrated as described in article 6 where ARS in adults without any sign of chronic lung disease or allergy is accompanied by a temporary reduction lung function. Future research should focus on the use of CRP in general practice, analysing cost-effectiveness of the use of CRP patient outcome in relation to antibiotic treatment, clarification of ARS as a female disease, and a detailed exploration of the relationship between URTI's and impaired lung function in lung-healthy patients.
PubMed ID
24495896 View in PubMed
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Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records.

https://arctichealth.org/en/permalink/ahliterature271494
Source
BMJ Open. 2015;5(7):e008096
Publication Type
Article
Date
2015
Author
David Tell
Sven Engström
Sigvard Mölstad
Source
BMJ Open. 2015;5(7):e008096
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Anti-Bacterial Agents - therapeutic use
Child
Cross-Sectional Studies
Drug Prescriptions - statistics & numerical data
Electronic Health Records
Female
General Practice - statistics & numerical data
Guideline Adherence - statistics & numerical data
Humans
Internship and Residency - statistics & numerical data
Male
Middle Aged
Practice Guidelines as Topic
Practice Patterns, Physicians' - statistics & numerical data
Professional Practice Location
Respiratory Tract Infections - drug therapy
Retrospective Studies
Sex Factors
Sweden
Young Adult
Abstract
To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums.
Retrospective study of structured data from electronic patient records.
Data were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database.
All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012).
Physicians' adherence to current guidelines for respiratory tract infections regarding the use of antibiotics.
We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors.
In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines.
Notes
Cites: Emerg Infect Dis. 2002 Mar;8(3):278-8211927025
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Cites: J Eval Clin Pract. 2012 Apr;18(2):473-8421210896
Cites: J Antimicrob Chemother. 2011 Dec;66 Suppl 6:vi3-1222096064
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Cites: J Fam Pract. 1982 Jul;15(1):111-77086372
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Cites: Lakartidningen. 2013 Apr 3-16;110(27-28):1282-423951882
PubMed ID
26179648 View in PubMed
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Adolescent self-rated health predicts general practice attendance in adulthood: Results from the Young-HUNT1 survey.

https://arctichealth.org/en/permalink/ahliterature298275
Source
Scand J Public Health. 2019 Feb; 47(1):37-44
Publication Type
Journal Article
Date
Feb-2019
Author
Øystein Hetlevik
Tina L Vie
Eivind Meland
Hans J Breidablik
David Jahanlu
Author Affiliation
1 Department of Global Public Health and Primary Care, University of Bergen, Norway.
Source
Scand J Public Health. 2019 Feb; 47(1):37-44
Date
Feb-2019
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Diagnostic Self Evaluation
Female
General Practice - statistics & numerical data
Health Care Surveys
Humans
Male
Norway
Patient Acceptance of Health Care - statistics & numerical data
Young Adult
Abstract
Self-rated health (SRH) is a predictor of future health. However, the association between SRH in adolescence and health problems and health care utilization in adulthood has rarely been investigated. The aim of this study was to examine adolescent SRH as a predictor of general practitioner consultations in adulthood.
SRH was registered in the Young-HUNT1 survey in 1995-1997 ( N=8828, mean age 16 years, 88% participation rate). General practitioner consultations during 2006-2014 were obtained from a national claims database. The predictive value of adolescent SRH on general practitioner consultations in adulthood was analysed by regression models estimating the relative risks (RR) for the total number of consultations and consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. Age, sex and baseline measures of chronic disease and health care attendance were used as the adjusting variables.
SRH was reported as 'very good' by 28.4%, 'good' by 60.6% and 'not good' by 11.0% of the respondents. The increases in consultation rates were 21% (RR 1.21, 95% CI 1.15-1.27) and 52% (RR 1.52, 95% CI 1.40-1.64) when comparing respondents with 'very good' SRH to those with 'good' and 'not good' SRH, respectively. We also demonstrated a dose-response association between adolescent SRH and general practitioner consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems.
SRH in adolescence is a predictor for general practitioner consultations in adult life. Previous research shows that SRH is influenced by factors such as well-being, health behaviour, functional status and body satisfaction. Intervention studies are needed to evaluate whether population-based and clinical interventions can improve SRH by improving these factors among adolescents.
PubMed ID
29708028 View in PubMed
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The adoption of new endodontic technology amongst Danish general dental practitioners.

https://arctichealth.org/en/permalink/ahliterature176908
Source
Int Endod J. 2005 Jan;38(1):52-8
Publication Type
Article
Date
Jan-2005
Author
L. Bjørndal
C. Reit
Author Affiliation
Department of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark. lb@odont.ku.dk
Source
Int Endod J. 2005 Jan;38(1):52-8
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Denmark
Dentist's Practice Patterns - statistics & numerical data
Diffusion of Innovation
Endodontics - instrumentation
Female
General Practice, Dental - statistics & numerical data
Humans
Male
Office visits - statistics & numerical data
Questionnaires
Root Canal Obturation - methods
Root Canal Preparation - instrumentation
Rubber Dams - utilization
Technology, Dental - statistics & numerical data
Abstract
To assess the adoption of new endodontic technology in a population of Danish practitioners.
Members of the Copenhagen Dental Association (n = 1156) were approached with a questionnaire concerning the frequency of various endodontic procedures. Three options were available: often, occasionally and never. Responses were anonymous. The statistical analyses were performed as studies of association in two- or three-way contingency tables, and with Goodman-Kruskal's gamma-coefficient as the basic tool chosen.
Only data from general practitioners (GPs) in private practice were analysed (n = 956). The response rate was 72%. NiTi hand instruments were often used to negotiate canals by 18%, whilst 10% often used NiTi rotary systems. Electronic apex locators were often employed by 15%. Nineteen per cent reported that warm gutta-percha was often used. A majority (53%) often spend two sessions to instrument a molar, and 20% often needed three or more sessions to finish the shaping phase. To complete a treatment of a nonvital case most practitioners reported to use at least three appointments. Only 4% frequently applied rubber dam.
The adoption of new endodontic technology is at an early stage amongst Danish GPs. A new revised remuneration system might influence the rate of adoption, allowing the practitioners to act more rationally and produce a higher frequency of good-quality root fillings. Progress towards high quality endodontics might be hindered by the nonuse of rubber dam.
PubMed ID
15606824 View in PubMed
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